I have consistently warned that doctors cannot afford to keep being the weakest link in the healhcare Arena. The consequences are beginning to manifest. Instead of taxing the right people(general public) for 'Universal healthcare'(which is politically risky) they will rather lay it all on physicians' shoulders, because they have realized physicians have no backbone.

"To fund the proposal, the lawmakers are seeking to raise taxes on cigarettes and health care providers"

Notice how they are lumping physicans in the same 'vilan' category as cigarette manufacturers. My question remains: At what point do physicians start fighting back?

I have consistently warned that doctors cannot afford to keep being the weakest link in the healhcare Arena. The consequences are beginning to manifest. Instead of taxing the right people(general public) for 'Universal healthcare'(which is politically risky) they will rather lay it all on physicians' shoulders, because they have realized physicians have no backbone.

"To fund the proposal, the lawmakers are seeking to raise taxes on cigarettes and health care providers"

Notice how they are lumping physicans in the same 'vilan' category as cigarette manufacturers. My question remains: At what point do physicians start fighting back?

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AMA has got to put strikes back on the table. The only reason why they can pull stunts like this with doctors is because we won't go on strike. If nurses can go on strike, so can we. It doesn't even have to be all of us at once you know, we could shut down just half of the hospitals for a month at a time to show them we mean business.

My guess is neighboring states will not do this, and drag doctors across the borders. It happened in PA with malpractice rates, and parts of PA were left without docs.

Striking sucks, but so does getting hit because you are bright enough to choose a profession that might pay reasonably well. They should hit those motherf*ckers that run the private insurance companies for a 5% or so, and see how much cheddar they get...

Well, how much do you really believe in universal healthcare? It's only ok if it doesn't have any effect on your income? While I don't believe that doctors should bear the entire weight of the economic burden of healthcare, 3% is a pretty small price to pay. I doubt that 3% is going to put any doctors in this country in the poorhouse.

Well, how much do you really believe in universal healthcare? It's only ok if it doesn't have any effect on your income? While I don't believe that doctors should bear the entire weight of the economic burden of healthcare, 3% is a pretty small price to pay. I doubt that 3% is going to put any doctors in this country in the poorhouse.

I personally think it's a GREAT idea and I'd like to see it apply to more areas.

I'd like to propose that grocery store employees be taxed 3% of their gross income in order to pay for the food stamp program.

I'd like to propose that lawyers be taxed 3% of their revenue to pay for the cost of public defenders.

I'd like to propose that teachers be taxed 3% of their gross income to pay for the ever increasing costs of education.

I'd like to propose that police officers, medics, and fire fighters be taxed 3% of their incomes to pay for crime enforcement and public safety.

I'd like to propose that fast food employees be taxed 3% of their gross incomes to pay for burgers and fries for poor kids.

And, I'd like to propose that politicians be taxed 99% of their gross incomes for the costs of eventually fixing the dumbass ideas and programs they propose. 99.9% if they are from California or Connecticut.

-Join the AMA and voice your disgust at the way they are allowing physicians to take a royal beatdown left and right.

-Physicians need to start unionizing wharever thay can.There is ~22% of physicians(and growing as more physicians become employees) that are not prevented from not only unionizing but striking by law. That group need to start exploring that option.

-There needs to be legal challenges and lobbys against antitrust laws that restrict some physicians from negotiating reimbursements as a union.

-STRIKES should no longer be a foreign concept to physicians. They must at least show an intention to strike even where they are prevented by law. Give the politicians something to think about.

-Launch a massive publicity campaign showing the rapid distruction of the medical profession(those that think physicians are rich need to be enlightened).

-If the AMA is not willing to put strikes back on the table, then abandon the AMA for a new association that is willing.

This is so short-sighted on the part of Connecticut lawmakers. I imagine many physicians with existing practices would end up paying the tax rather than moving out of state, BUT I also imagine people like myself who are still at the med school stage will actively seek to avoid Connecticut for residency and post-residency.

I am not opposed to universal health care, (I actually intend to provide a fair amount of 'pro bono' care once I'm in practice) but "universal" should refer to both the coverage and to the funding mechanism.

Well, how much do you really believe in universal healthcare? It's only ok if it doesn't have any effect on your income? While I don't believe that doctors should bear the entire weight of the economic burden of healthcare, 3% is a pretty small price to pay. I doubt that 3% is going to put any doctors in this country in the poorhouse.

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Taxing only doctors, and taxing their revenue just doesn't make any sense. How about taxing everyone's income, with proportionally larger taxation of larger incomes. I'm willing to take a hit as a citizen, but not be singled out to carry the burden of national health care. I've already chosen to work long hours and take an education path that delays actually earning a proffessional salary for many additional years to contribute to healthcare, and many physicians provide a certain amount of free care and provide to low reimbursement populations like medicare patients . . . how much more am I personally obligated to give that every other citizen isn't?? Why shouldn't this burden be shared by all the people in this country who could spare a chunck of change by taxing income??

I don't necessarily agree with the method proposed, but we are pretty blind to think that we won't have to make any sacrifices for universal healthcare. Whether it's direct pay cuts or taxes, doctors will probably have to get by with less.

I don't necessarily agree with the method proposed, but we are pretty blind to think that we won't have to make any sacrifices for universal healthcare. Whether it's direct pay cuts or taxes, doctors will probably have to get by with less.

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For as long as doctors are not the only ones taking a hit, then we are fine. What you have here is outright victimization of a small group for the benefit of others(for political gains). If society wants Universal healthcare, the right thing will be for society to pay for it. BTW, it is not physician income that is responsible for our huge healthcare expenditure or our lack of universal healthcare. If it was, then as physicians income has been declining in the last decade, why is our healthcare expenditure rising?

Maybe that sounds crass, but let me tell you a true story. I have a friend from high school - the guy is the blue ribbon, grade "A", certified laziest person I have ever met in my life. (I still love the guy, but it's just the sad truth). He has not done anything with his life since high school (which by the way was over 10 years ago), despite being very intelligent and capable of succeeding in a number of fields. He works 8-10 hours a week for his uncle, lives in his parents' basement (I'm not kidding) and spends all his free time and money (because his parents pay everything) bowling and going bar hopping. I have tried time and again to convince him to do something with his life, but he refuses to go to school and refuses to consider working full time because he is "too busy" (bowling and bar hopping).

Can someone please tell me why it should be my responsibility and obligation to be taxed up the butt for his healthcare? I don't mind helping people who truly need it (I'm all for medicare and medicaid) and I even think we do need to have some drastic overhauls to make healthcare more affordable and accessable (think insurance industry overhauls here folks, not raping doctors). But I feel no obligation or need to spend 13-15 years of my life in intense educational pursuits and then working my butt of 60 hours a week or more for the rest of my life so that I can pay for his healthcare. Is that so wrong? He needs to take responsibility for his own self (oh wait, encouraging personal responsibility, I forgot what a sin that is on this board and in the medical industry in general).

And that's the problem I have with universal care. It may help some people who need the help, but it also obligates hard workers to take care of lazy folks. I mean, heck, if I can get everything paid for I'd be an idiot to work so hard. Perhaps if things keep changing the way they are I'll just work in private practice 5 hours a week and live off of universal healthcare and foodstamps.

I don't necessarily agree with the method proposed, but we are pretty blind to think that we won't have to make any sacrifices for universal healthcare. Whether it's direct pay cuts or taxes, doctors will probably have to get by with less.

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It is statements like this that really make me think we are not educating the medical students enough in the way health care economics really works. The truth is that doctors have been taking huge cuts for years. In the next 10 years the payments to physicians for services will be cut by 38%. It is already so dismal that many physicians won't take medicare

Thankfully congress has worked to postpone them for the last several but there have been no increases. So even though the cost of healthcare has gone up by three times inflation the payments to doctors have gone DOWN based on inflation. What does this mean??? Payments to doctors are not causing the problem. Stop trying to bleed people who have already sacrificed alot for this countries medicine and are the reason it is as good as it is. (And don't quote that Cuba ranking bull****...any ten year old could have seen how flawed that study was...the UN needs to stick to peace keeping...oh forgot they don't do that either)

At the same time payments to hospitals, pharms, etc have all gone up each year.

Health care cannot be built on the backs of the people that are the ones keeping it together in the first place. This cannot continue.

And that's the problem I have with universal care. It may help some people who need the help, but it also obligates hard workers to take care of lazy folks. I mean, heck, if I can get everything paid for I'd be an idiot to work so hard. Perhaps if things keep changing the way they are I'll just work in private practice 5 hours a week and live off of universal healthcare and foodstamps.

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I agree, but I don't think this makes universal healthcare impossible. Do it via an income tax, but you can only qualify if you are 1) a hard working contributing citizen 2) the dependent of a hard working contributing citizen or 3) legally disabled and therefore unable to be a hard working contributing citiezen. You don't get your card if you can't prove one of the above each year, . . . if you contribute to society (and therefore contribute something proportional to your income to the system) or are really unable to (think disabled war vet, clinicallly insane etc) then you should reap the benefits of being a part of our society. If you refuse to participate then you are SOL.

I agree, but I don't think this makes universal healthcare impossible. Do it via an income tax, but you can only qualify if you are 1) a hard working contributing citizen 2) the dependent of a hard working contributing citizen or 3) legally disabled and therefore unable to be a hard working contributing citiezen. You don't get your card if you can't prove one of the above each year, . . . if you contribute to society (and therefore contribute something proportional to your income to the system) or are really unable to (think disabled war vet, clinicallly insane etc) then you should reap the benefits of being a part of our society. If you refuse to participate then you are SOL.

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I agree with your ideas also, but I don't agree that it does make universal healthcare possible. Because what you are proposing is not universal healthcare at all. Universal healthcare specifically (as I understand it) means healthcare for EVERYONE - not just contributing members to society. Correct me if I'm wrong, but my understanding is that the idea of universal healthcare is to cover everyone regardless of any factors such as their willingness to contribute to society.

I especially liked the last line in the article that the people testifying didn't have any suggestion as how to raise the revenue to pay for the plan without this insane tax on physician revenue.

I have an idea.

If universal healthcare is really that important, just raise income taxes. Tax everyone equally. Add 5%, 10%, whatever it takes to the state income tax. Then see how popular this idea is with the people of CT and how many people chose to relocate out of the Peoples Republic of Connecticut.

I have a sneaking suspicion significantly increasing the income tax rate would be political suicide, but perhaps that's the cost of providing universal healthcare.

In 2001 (too lazy to find newer numbers http://www.city-data.com/states/Connecticut-Public-finance.html) CT had a total state revenue of $17,750,445,000. If the extra tax on physicians is supposed to generate $600,000,000, then they only need to increase their total revenues by 3% overall to pay for this amount without taxing physicians. Surely a moderate income tax hike (wasn't able to find total income tax revenues) would generate $600M. I mean, that's less than they spent on roads in 2001.

With a population of 3,000,000 CT only needs to raise $200 per resident to avoid this physician tax. They could simply call their universal health care an insurance plan and require everyone to pay $200. If people aren't willing to pay $200/yr for their universal healthcare I question whether they really want it.

I especially liked the last line in the article that the people testifying didn't have any suggestion as how to raise the revenue to pay for the plan without this insane tax on physician revenue.

I have an idea.

If universal healthcare is really that important, just raise income taxes. Tax everyone equally. Add 5%, 10%, whatever it takes to the state income tax. Then see how popular this idea is with the people of CT and how many people chose to relocate out of the Peoples Republic of Connecticut.

I have a sneaking suspicion significantly increasing the income tax rate would be political suicide, but perhaps that's the cost of providing universal healthcare.

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Yeah, unfortunately it might not be politically possible to convince people to pay more in taxes. However, it's a universal benefit, so it should be universally supported -- it's not right to stick any one group with a big chunk of the expense.

The thing that's illogical about people objecting to paying more in taxes is that they still might come out ahead because they'll pay less for insurance. Monthly insurance premiums are becoming a huge burden for lots of Americans and will eventually be a burden for every American with insurance -- the days of your employer paying the bulk of your premiums are gonna end and probably not too long from now. I know my last employer was forever decreasing the amount of premiums that they covered, and my insurance kept on going up by a huge percentage every year.

The problem is that most people in the public view doctors us a bunch of greedy, rich people. Unfortunately, there's some truth to that perception. However, I think the AMA needs to be focusing on some PR to improve our images. Schools are doing that with the whole professionalism craze, but I don't see that really fixing anything.

I have consistently warned that doctors cannot afford to keep being the weakest link in the healhcare Arena. The consequences are beginning to manifest. Instead of taxing the right people(general public) for 'Universal healthcare'(which is politically risky) they will rather lay it all on physicians' shoulders, because they have realized physicians have no backbone.

"To fund the proposal, the lawmakers are seeking to raise taxes on cigarettes and health care providers"

Notice how they are lumping physicans in the same 'vilan' category as cigarette manufacturers. My question remains: At what point do physicians start fighting back?

I agree, but I don't think this makes universal healthcare impossible. Do it via an income tax, but you can only qualify if you are 1) a hard working contributing citizen 2) the dependent of a hard working contributing citizen or 3) legally disabled and therefore unable to be a hard working contributing citiezen. You don't get your card if you can't prove one of the above each year, . . . if you contribute to society (and therefore contribute something proportional to your income to the system) or are really unable to (think disabled war vet, clinicallly insane etc) then you should reap the benefits of being a part of our society. If you refuse to participate then you are SOL.

They grab up all the healthy people who work for good companies that will pay their health insurance and then when their 'customers' are too old to work (and your health starts to really need some serious help), the insurance companies dump you onto medicare.

They've got a crazy racket by skimming off the population with the least number of health risks and charging them the most money for their health care.

Why is it always doctors that get held up as the bad guys in health care costs? Private insurance companies, many of which are beholden to turn a profit share holders by putting the financial squeeze on drs AND the public, have been making out like bandits...

<sigh>

I promised myself I wouldn't get involved in these 'reforming health care' / 'universal coverage' threads, but I don't have an exam this week and the kids are sleeping, so... a rare free moment has been squandered here on SDN trying to solve an intractable problem that I doubt I have a complete understanding of anyway....

I personally think it's a GREAT idea and I'd like to see it apply to more areas.

I'd like to propose that grocery store employees be taxed 3% of their gross income in order to pay for the food stamp program.

I'd like to propose that lawyers be taxed 3% of their revenue to pay for the cost of public defenders.

I'd like to propose that teachers be taxed 3% of their gross income to pay for the ever increasing costs of education.

I'd like to propose that police officers, medics, and fire fighters be taxed 3% of their incomes to pay for crime enforcement and public safety.

I'd like to propose that fast food employees be taxed 3% of their gross incomes to pay for burgers and fries for poor kids.

And, I'd like to propose that politicians be taxed 99% of their gross incomes for the costs of eventually fixing the dumbass ideas and programs they propose. 99.9% if they are from California or Connecticut.

If a union or strike is not possible (or legal) for physicians, whats to prevent a large group of physicians from threatening to leave the state if legislation goes through. Surely if a large enough group of people threatened to do this, that would prevent the state from passing such a tax.

Another question I have for the great minds at Connecticut is: How is this program sustainable when physicians' revenue could go down for any number of reasons including an exodus from connecticut? Also, if people followed our advice and stopped smoking your funding from cigerrete taxes will go down, or are you planning on making sure people keep smoking to sustain your universal healthcare?

I don't necessarily agree with the method proposed, but we are pretty blind to think that we won't have to make any sacrifices for universal healthcare. Whether it's direct pay cuts or taxes, doctors will probably have to get by with less.

I have read articles about doctors trying to unionize in 1999, but NOTHING has been done since? Does anyone know what happened? There was an article in the NY Times I think it is still available about doctors unionizing in 99 but its been 8 years and nothing?

I have consistently warned that doctors cannot afford to keep being the weakest link in the healhcare Arena. The consequences are beginning to manifest. Instead of taxing the right people(general public) for 'Universal healthcare'(which is politically risky) they will rather lay it all on physicians' shoulders, because they have realized physicians have no backbone.

"To fund the proposal, the lawmakers are seeking to raise taxes on cigarettes and health care providers"

Notice how they are lumping physicans in the same 'vilan' category as cigarette manufacturers. My question remains: At what point do physicians start fighting back?

Another question I have for the great minds at Connecticut is: How is this program sustainable when physicians' revenue could go down for any number of reasons including an exodus from connecticut? Also, if people followed our advice and stopped smoking your funding from cigerrete taxes will go down, or are you planning on making sure people keep smoking to sustain your universal healthcare?

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It's a good question, but I doubt any of these politicians will care either way. Sustainability and really helping people means nothing to them. All they care is to look good and sound good to the voting block with below 80 IQs. Keeps them in power for now and then when the system implodes 10 years down the road they can just find someone else to blame and victimize.

I agree, but I don't think this makes universal healthcare impossible. Do it via an income tax, but you can only qualify if you are 1) a hard working contributing citizen 2) the dependent of a hard working contributing citizen or 3) legally disabled and therefore unable to be a hard working contributing citiezen. You don't get your card if you can't prove one of the above each year, . . . if you contribute to society (and therefore contribute something proportional to your income to the system) or are really unable to (think disabled war vet, clinicallly insane etc) then you should reap the benefits of being a part of our society. If you refuse to participate then you are SOL.

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Hmmm...

I 110% agree with your idea. The problem is that government in not capable of doing this. Look at every entitlement program there is.

Food stamps: we are in a land of plenty, nobody should starve. Now look at the execution of the food assistance program today. No more "stamps" too demeaning now they have a credit-type card (EBT). Gone are the days of beans, rice, meat and gubament cheese. People can (and do) buy T-bone steak, Brand name Coke, Little Debbies and on and on. I realized how crazy this was a long time ago when I was checking out at the grocery store with my Save-a-lot brand pasta and the guy ahead of me was paying for a STACK of filets mignon with the food stamp card!!!!!

Medicaid: Ever worked in the ER? We all know about the widespread abuse of ERs in general. I couldn't begin to tell you the number of times I've seen people pull up to the ER in a new car, put out a Marlboro, talking on their new cell phone, dressed in brand named clothing come in to the ER and pull out their "gold card." My former state started a Medicaid abuse hotline to report people abusing the ER. I called several time on people with stuff like 20 visits in 3 months. Guess what happened? Nothing.

HUD: Back in my paramedic days, I could not tell you how many section 8 houses I went to with big screen TVs and nice stereos.

I'm not against all government programs, but I can guarantee you that Universal Healthcare will not allow for any personal accountability like you describe and will be a disaster for all.

This is a hilarious idea. The next time I'm at McDonald's I'm going to refuse to pay anything above 1/2 of what they tell me the price is, and then insist the cashiers pool together to come up with the money. As long as the till's even, it makes sense.

It's premature to get riled about this. Even if Cali and CT pass these laws, the medical groups will file a lawsuit claiming it's unconstitutional to target one profession, especially if we didn't contribute to people's health problems in the first place. Tobacco is different because they knowingly caused the health problems. I think the courts would agree. Any lawyers here want to comment?

I more afraid of the universal healthcare bill that Congress will eventually pass.

It's premature to get riled about this. Even if Cali and CT pass these laws, the medical groups will file a lawsuit claiming it's unconstitutional to target one profession, especially if we didn't contribute to people's health problems in the first place. Tobacco is different because they knowingly caused the health problems. I think the courts would agree. Any lawyers here want to comment?

I more afraid of the universal healthcare bill that Congress will eventually pass.

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As many things as doctors have let slide, what makes you think they can organize themselves to do this? The underlying problem is that physicians have not shown the will to fight.

It looks like physician pay is going to face significant downward pressure, and I'm not sure that anything will be done about that by physicians who appear to be the weakest link in the health care economics chain. Once these politicians taste blood, I'm looking for that tax to go up from 3% (maybe 10% is next?).

Under a cash system, this tax could just be passed on directly to the patient, but most physicians depend on insurance, so it's tougher to recover that 3%. However, if you're not going into medicine for the money ... there should still be enough money to repay that education and earn a middle-class living in the worst case and probably live upper-middle class as the more likely case.

Yes, a lot of people who are going into it now would find something else to do, but there are thousands of other pre-meds willing to work for penuts to take their place given some time. Look at teachers ... what do they make ... $40K or $50K? There seems to be no lack of them. I don't see physician pay going that low (maybe $80K on the low end). More than likely physicians will continue to make north of $120K in today's dollars by my estimation. It also doesn't look like there will be a lack of sick people to treat either, so job security should be relatively good compared to most professions.

It looks like physician pay is going to face significant downward pressure, and I'm not sure that anything will be done about that by physicians who appear to be the weakest link in the health care economics chain. Once these politicians taste blood, I'm looking for that tax to go up from 3% (maybe 10% is next?).

Under a cash system, this tax could just be passed on directly to the patient, but most physicians depend on insurance, so it's tougher to recover that 3%. However, if you're not going into medicine for the money ... there should still be enough money to repay that education and earn a middle-class living in the worst case and probably live upper-middle class as the more likely case.

Yes, a lot of people who are going into it now would find something else to do, but there are thousands of other pre-meds willing to work for penuts to take their place given some time. Look at teachers ... what do they make ... $40K or $50K? There seems to be no lack of them. I don't see physician pay going that low (maybe $80K on the low end). More than likely physicians will continue to make north of $120K in today's dollars by my estimation. It also doesn't look like there will be a lack of sick people to treat either, so job security should be relatively good compared to most professions.

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You may want to recheck your facts on teachers though. In TX, there is such a lack of teachers that you don't need certification to get a job. You actually don't even need a college degree. That is how bad TX needs teachers.

You may want to recheck your facts on teachers though. In TX, there is such a lack of teachers that you don't need certification to get a job. You actually don't even need a college degree. That is how bad TX needs teachers.

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I dunno. I've known several teachers, and getting the "good jobs" in Austin, for example, is actually quite competitive. I have never met a teacher who didn't have a college degree (and I have met hundreds in Texas) and I know of several who couldn't get jobs at the schools they wanted. Sure, if you want to teach in the Valley, there are plenty of those spots, and you're right, they keep lowering the standards. The same thing could happen in medicine ... mid-levels will do more of the work. Cost is becoming a bigger and bigger issue in medicine, and physicians making $300K or even $200K or less make a target that politicians seem to like right now.

On the other hand, do we need better teachers ... yes. Are Texans willing to pay for great teachers for all? No. Even private school teachers aren't generally making > $100K. I see a similar situation in health care. The average Texan is totally unwilling to pay more in taxes, medical bills, or whatever so that some currently uninsured person can "freeload" off of them. When most people on Medicaid appear to be abusing the system, it is going to very difficult to get Texas taxpayers to spend even more on taxes for medical care. We have a big problem and it's going to be a challenge to resolve it in a way that anyone, including physicians, will find acceptable.

It looks like physician pay is going to face significant downward pressure, and I'm not sure that anything will be done about that by physicians who appear to be the weakest link in the health care economics chain. Once these politicians taste blood, I'm looking for that tax to go up from 3% (maybe 10% is next?).

Under a cash system, this tax could just be passed on directly to the patient, but most physicians depend on insurance, so it's tougher to recover that 3%. However, if you're not going into medicine for the money ... there should still be enough money to repay that education and earn a middle-class living in the worst case and probably live upper-middle class as the more likely case.

Yes, a lot of people who are going into it now would find something else to do, but there are thousands of other pre-meds willing to work for penuts to take their place given some time. Look at teachers ... what do they make ... $40K or $50K? There seems to be no lack of them. I don't see physician pay going that low (maybe $80K on the low end). More than likely physicians will continue to make north of $120K in today's dollars by my estimation. It also doesn't look like there will be a lack of sick people to treat either, so job security should be relatively good compared to most professions.

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That might be the most out of place comparison that I have ever seen(and I see it a lot on SDN). First of all I was a teacher for 1 year. Let me see:

-3 months off in a year.
-Minimal requirement to qualify for the job(4 years undergrad)
-No liability/litigation.
-No significant debt.
-Easy schedule

Pay is not only $$, there are perks that have huge value involved with being a teacher. I was never under any form of stress whatsoever, infact the more you guys talk about teaching, the more I get tempted to go back.

A physician on the other hand is getting beat down with litigation, logging huge amounts of hours, laden with debt, and operates under high stress.